To date, more than three thousand brain and skull base tumors, along with various vascular problems, have been treated by using advanced, fully endoscopic, minimally invasive surgical techniques. In this book, Dr. Hrayr K. Shahinian, director of the Skull Base Institute, compiles these techniques. The book is highly specific and amply illustrated. The step-by-step operating room procedures provide a definitive guide to the difficult yet essential art of skull base surgery.

I am honored to be asked to write a foreword to this comprehensive and fascinating book on skull base surgery (SBS) by Dr. Shahinian, who I consider among the pioneers in the field. I should start by writing a disclaimer. I first met Dr. Shahinian when he was a brilliant surgical resident at Vanderbilt University Medical Center in 1986. Over the next several years, I had the pleasure of following his career through different training rotations in the United States and abroad. I remember well when he told me that skull base surgery was his career choice. I thought it was a high-risk career move considering that the discipline was still in its early development. As a result, I was quite gratified to follow Dr. Shahinian’s professional success as he developed the Skull Base Institute, initially in New York, and later in Los Angeles.

I would like to first define SBS from my perspective as a general surgeon. SBS denotes a group of operations involving the base of the skull or its contents. The skull base is divided into an anterior (attached to the facial skeleton), middle, and posterior areas. Vital arteries, veins, as well as cranial nerves pass through the skull base. Consequently, this part of the skull has historically been the most difficult to access, and lesions of the skull base were often associated with a poor prognosis.